Does really aggressive ACL surgery rehab make a difference? As you may know, we’re not big fans of surgery to replace torn knee ACL ligaments. This is because the ligament repair bears no resemblance to the original equipment. In addition, recent research has shown that the chances of injuring the opposite, normal knee go way up after an ACL surgery, likely due to abnormal biomechanics in the operated knee. So the outcome of a new study that looked at aggressive rehab after a knee ACL reconstruction surgery was no surprise.
The authors randomized 36 patients who were using their hamstrings tendon to reconstruct the ACL into either very aggressive physical therapy or to light PT after surgery. The results? There was no differences between the groups on any measure. Why is this not surprising? In this early phase of care after surgery (up to 6 months), the ACL graft is likely strong and it’s tightness is all that matters for knee stability. So while having strong muscles might help in the long-run if you don’t have an ACL at all, even an artificial ACL placed at the wrong angle (as all artificial ACLs are-see A and B above) will trump muscular activity for stability. Now run this out a few years and you might see differences, as in our clinical experience, the graft shear of the artificial ACLs vertical positioning will eventually loosen the new ACL (see C above). So perhaps getting stronger and staying stronger would make more difference over longer periods of time.
The upshot? Really aggressive PT after an ACL surgery doesn’t seem to make a big difference in short-term outcome. Having said that, we would ask another question-why allow your ACL to be surgically ripped out in the first place if there’s a chance at healing it?